Project Summary Research Objective 5. The proposal is responsive to the funding announcement, "Preventing Unintentional Injuries (R21)", specifically, research objective 5: Research on implementation and dissemination of effective interventions. The broad goal of this project is to develop better ways of disseminating successful injury prevention programs to those organizations that can use them to decrease injury morbidity and mortality. We will use organizational and administrative factors collected by surveys with US children's hospitals to develop prognostic models for the adoption of an evidence-based childhood injury prevention program, Safe N'Sound (SNS) and develop an audience analysis report and dissemination strategy based on our findings. Importance. Findings from this project will broaden the fundamental knowledge of how programs are translated to nationwide healthcare systems not only to assist the National Association of Children's Hospitals and Related Institutions (NACHRI) in its efforts but potentially other bodies wishing to disseminate prevention programs and practices. Objectives. The specific aims of this project are: Aim 1: Develop and validate empirical models using organizational and administrative factors to predict the adoption of SNS. To accomplish this aim, we will: 7 Develop and launch a web-based survey of children's hospitals to describe current injury prevention programming and factors that are associated with such programming;7 In partnership with the NACHRI, offer the full Safe N'Sound program package to all member hospitals using the current dissemination approaches employed by NACHRI;and 7 Conduct a follow-up survey of member hospitals to assess SNS program adoption and features of the program that are perceived to be related to its adoption. Aim 2: Evaluate the misclassification associated with the predictive models and from this, generate an audience analysis report and an active dissemination strategy. To accomplish this aim we will: 7 Conduct a CART analysis using follow-up survey data to identify features of the innovation that are related to model misclassification;and, 7 Use these features to enhance the dissemination strategy suggested by the prognostic models in aim 1. Study Design. The proposed project is an observational study, or a natural experiment. Setting: This study will be administratively housed at Saint Louis University and conducted in partnership Carolinas Medical Center in Charlotte North Carolina, the National Association of Children's Hospitals and Related Institutions (NACHRI), the National Institute of Child Health and Human Development (NICHD) and the Brown Center for Violence and Injury Prevention at the George Warren Brown School of Social Work at Washington University in St. Louis. Participants. Of the 218 NACHRI members, 187 meet the inclusion criteria for this study, which includes: US- based, full members from either a freestanding children's hospital or a primary teaching hospital or are associate or supporter level members. We will recruit every one of these 187 eligible NACHRI members for this study. Representing each hospital, we will invite the CEO and the Injury Prevention Coordinator to participate and will provide incentives for this participation. Outcome Measures. This R21 study is not designed to change particular outcomes, but to collect cross- sectional information to develop the models and products described above. Generally speaking, we will capture the following information as outcomes of this process: adoption of injury prevention programs in general, adoption of Safe N'Sound, and factors related to adopting or not adopting such programs. PUBLIC HEALTH RELEVANCE: Project narrative The aims of this project are to develop and validate empirical models of injury prevention programming by children's hospitals and to use these models to develop active dissemination strategies. Findings of this study will allow us to better promote effective injury prevention programs and support their adoption and implementation in clinical settings. By extending the reach of successful programs, we can increase the number of parents who receive such programs, and thus decrease the burden of childhood injuries.